Walkthrough: Pharmacological and Parenteral Therapies Q4 – NCLEX-RN®

by Rhonda Lawes, PhD, RN

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    00:01 A client has been taking oxycodone for pain for several weeks.

    00:05 Which sign indicates to the nurse that the client might have developed a tolerance to the drug.

    00:11 Okay, so, we know they've been on oxycodone, that's a drug we're talking about. Right? So what type of med is that? It's an opioid for pain. That makes sense.

    00:21 They've been on it for a while.

    00:23 So which sign indicates the nurse that the client might have developed tolerance? What does that mean? Well, when the body builds up a tolerance, the same dosage doesn't have the same level of effectiveness for them anymore.

    00:37 So, now, let's look at the answer choices.

    00:40 There we go. Just four, right? This is just one of the answer. We're not a select all that apply.

    00:46 This is just what is the most correct answer.

    00:49 Please write down 1, 2, 3, 4.

    00:52 Pause the video.

    00:53 Walk through each of these answer choices, eliminate instead of gravitating and say why on each question, then start the video again, and we'll walk through it together.

    01:12 So I'm looking for something that indicates tolerance.

    01:14 So, would number one indicate tolerance? The medication is just as effective as it was at the beginning.

    01:23 Nope. Because the work we did and the topic of the question, we know that tolerance means it's not as effective.

    01:29 So number one is out.

    01:31 Number two, the client no longer gets constipated when taking oxycodone.

    01:37 Now, that's a whole another issue. That isn't tolerance.

    01:39 So, no. In fact, really, tolerance to constipation doesn't really occur.

    01:44 If a patient has a problem with opioids, that problem lingers, unfortunately.

    01:50 So one and two, they're out.

    01:52 Number three.

    01:53 The client has withdrawal symptoms when stopping the medication.

    01:58 Is that tolerance? No.

    02:01 That means, they didn't wean the medication.

    02:04 And because they've been on it for several weeks.

    02:06 Wow. That's why they had withdrawal symptoms.

    02:09 So it's so important in a CNS medication, like a pain medication and opioid that you work with the healthcare provider to slowly wean.

    02:18 Gradually take smaller and smaller doses, with longer periods of time in between those doses, so the body can adjust to the change.

    02:27 So we've eliminated 1, 2, 3.

    02:29 I hope in four works.

    02:31 The client asked for the medication more often.

    02:34 That means tolerances build up.

    02:37 Before when they started the medication, maybe the patient could go every six to eight hours, and they had enough relief and pain control.

    02:44 But now, they're starting to really feel that pain revved up before that six to eight hours.

    02:51 That's why they're asking for it more often.

    02:53 That would be an indication that the patient has built up a tolerance.

    02:57 Now we have an opioid crisis in the United States.

    03:00 They were over prescribed for a period of time in our history, but they have a place in healthcare.

    03:07 So don't assume that someone who's requesting treatment for pain is just seeking drugs.

    03:14 Sometimes health care providers have a real bias against that.

    03:17 Remember, pain in practice.

    03:20 And in NCLEX is what the patient reported to be.

    03:25 If you sense there's some type of problem or other issue going on, maybe you sense there could be an underlying addiction issue that is outside of the scope of a nurse, right.

    03:36 That's outside of our scope of practice.

    03:38 So you need to make the appropriate referral with the healthcare provider to get the patient the help they need and deserve.

    03:45 Okay, good job.

    03:46 Now you're ready for the next question.

    About the Lecture

    The lecture Walkthrough: Pharmacological and Parenteral Therapies Q4 – NCLEX-RN® by Rhonda Lawes, PhD, RN is from the course NCLEX-RN® Question Walkthrough: Pharmacological and Parenteral Therapies.

    Included Quiz Questions

    1. Walk through each option first and eliminate the ones that seem incorrect.
    2. Select the third option every time.
    3. Select the first option that seems correct.
    4. Automatically eliminate the first option, as it is rarely the correct one.
    1. Ask the client about their pain.
    2. Assess the client’s body language.
    3. See how much pain medication the client is prescribed.
    4. Ask the outgoing nurse how often the client asked for pain medication.

    Author of lecture Walkthrough: Pharmacological and Parenteral Therapies Q4 – NCLEX-RN®

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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